Filter Wealth vs Intelligence

Photo by Luthfiah VOI

JAKARTA - The world currently spends $100 billion each year on medical education. At the microeconomic level, the cost of medical school tuition in many countries now reaches $14,000 per year. This will seem like a very large amount for an 18-year-old high school graduate from an average financial background. Economic depression makes these numbers seem even bigger, for the country and for individuals.

When a product or service is expensive, we naturally assume that it's because the cost of producing or providing it is very high. However, that's not always true. Tuition is an example. Tuition has increased in recent years, but it may not be the real increase.

Tuition fees are rising, but the number of students with low-interest loans is also increasing - logic suggests that the increase in tuition fees leads to an increase in student loans - but could the opposite be true? What would happen to house prices if the government guaranteed loans with very low interest to anyone who wanted to buy a house. House prices will naturally rise. Could the widespread availability of very low-interest loans also drive tuition inflation?

Based on health journals and the National Library of Medicine website, another factor that can drive prices and is not related to production costs is demand. If the demand for goods or services increases, then prices will also increase. Of course, the demand for medical education is very high. The ratio of applicants to medical schools to candidates accepted is 16:1. It is not surprising that with this level of competition the price will rise.

As demand rises, so do offers. Limited supply also drives up prices. Most medical schools are only allowed to accept a limited number of students each year so supply is limited. Even if schools are allowed to accept more students, the traditional education model still used by many of them would mean that they cannot provide a similar education to significantly more students. Only by rethinking their model of education provision can they achieve this. The move towards massive open online courses (MOOCs) shows that some institutions are rethinking their model, but the provision of MOOCs in the context of medical education brings its own problems.

Children of Workers and Farmers Difficult to Become Doctors?

Medical education in Indonesia is at a worrying crossroads. On one side, the country is experiencing a chronic shortage of doctors - with a ratio of only 0.69 doctors per 1,000 residents far below the WHO standard of 1:1,000 - but on the other hand, access to this profession increasingly resembles an exclusive club that can only be entered by those with exorbitant financial power. This phenomenon is no longer just a matter of education costs, but a systematic social filtering.

It is common knowledge that the entrance fee for the Faculty of Medicine (FK), especially through the independent path at various State Universities (PTN) and private, has touched a fantastic figure. In some campuses, the Institutional Development Fee (IPI) or the base money can range from Rp. 120 million to hundreds of millions of rupiah, even in certain private universities the total cost can penetrate the billion rupiah.

The Secretary General of the Indonesian Medical Education Institute Association (AIPKI), Riyani Wikaningrum, indeed argues that the high cost is comparable to the high cost of laboratory operations and practice materials. However, when these numbers become "barriers" that intelligent workers or farmers cannot cross, medical education has shifted from academic meritocracy to financial aristocracy.

The biggest concern of this phenomenon is the birth of a generation of doctors who have a profit-centric orientation. Education observer from Tamansiswa, Ki Darmaningtyas, warns that the commercialization of education that is increasingly vulgar will force its graduates to think about the fastest way to get Return on Investment (ROI).

The logic is simple but terrifying: if someone has to spend Rp1 billion to become a doctor, it is unlikely that they will be willing to be placed in remote areas with low salaries or provide free medical services. This system indirectly "kills" the idealistic character from the university bench.

Deputy Chairman II of the Indonesian Medical Council, Satryo Soemantri Brodjonegoro, even noted that the dominance of fund power often overrides the quality of character and academic eligibility, which leads to a decline in competence standards.

But the above question was immediately dismissed by the facts. The young man who was once only a potato farmer's child but now can become a dentist as well as a musician. He considers these two professions as professional jobs.

The man who is familiarly called Nova has helped his parents work since he was a child. Nova's parents only work as potato farmers in the village of Patak Banteng, Dieng, Wonosobo. Since elementary school, this child of three siblings often helps his parents go down to the potato plantation to plant and harvest potatoes.

"From elementary school, my parents and my two younger brothers have been asked to help in the garden. Yes, planting potatoes. When it's time to harvest, I have to help pick the good potatoes. After that, they are sold to the markets in the city (Wonosobo)," said Nova when met in Pecenongan, Central Jakarta.

With a life that is poor and uncertain, finally after graduating from Nova Elementary School, his parents were transferred to the city of Wonosobo to find a good SMP. According to Nova at that time, his parents wanted him to be able to go to school better, so that later Nova would not become a farmer like his parents. As is known, Nova's parents were not highly educated.

Nova always believes that nothing is impossible if someone wants to try and work hard. What he has done so far is a proof that even a small person can become great. Keep praying and trying to be useful later.

"No one would have thought, I used to be a potato farmer who was very poor. Now I can serve in the medical field," he said.

Threats to National Health Resilience

If the profession of doctors is only filled by the upper economic class, then the inequality in the distribution of medical personnel will continue to be a gaping wound. Data shows that Indonesia is predicted to lack 70,000 specialist doctors by 2032. However, these "expensive" doctors tend to gather in big cities in order to chase back capital through profitable private practices, leaving communities in remote areas without adequate health services.

Medical education should be an instrument of vertical mobility for the intelligent children of the nation, not a class reproduction tool for those who are already established. Without serious intervention from the government to subsidize the cost of medical education significantly or expand the full scholarship scheme with service bonds, health in this country will remain a luxury commodity that can only be accessed by those with deep pockets.

"We don't need just rich doctors, we need doctors who are present because of a calling of the soul, without having to be burdened with debts of billions of rupiah when they have just taken the oath," he said.